Treatment De-escalation in Relapsing-Remitting Multiple Sclerosis: An Observational Study

• DOI: 10.1007/s40263-025-01164-w
• Publication Date: 2025-02-14T18:54:21Z
• Authors: Jannis Müller; Sifat Sharmin; Johannes Lorscheider; Dana Horakova; Eva Kubala Havrdova; Sara Eichau; Francesco Patti; Pierre Grammond; Katherine Buzzard; Olga Skibina; Alexandre Prat; Marc Girard; Francois Grand’Ma...; Raed Alroughani; Jeannette Lechner...; Daniele Spitaleri; Michael Barnett; Elisabetta Cartec...; Maria Jose Sa; Oliver Gerlach; Anneke van der Walt; Helmut Butzkueven; Julie Prevost; Tamara Castillo-T...; Bassem Yamout; Samia J. Khoury; Özgür Yaldizli; Tobias Derfuss; Cristina Granziera; Jens Kuhle; Ludwig Kappos; Izanne Roos; Tomas Kalincik
• Keywords: Relapsing remitting; Psychopharmacology

In relapsing-remitting multiple sclerosis (RRMS), extended exposure to high-efficacy disease modifying therapy may increase the risk of side effects, compromise treatment adherence, and inflate medical costs. Treatment de-escalation, here defined as a switch lower efficacy therapy, is often considered by patients physicians, but evidence guide such decisions scarce. this study, we aimed compare clinical outcomes between who de-escalated versus those continued their therapy. retrospective analysis data from an observational, longitudinal cohort 87,239 with (MS) 186 centers across 43 countries, matched episodes adult RRMS underwent de-escalation either high- medium-, low-, or medium- low-efficacy counterparts that treatment, using propensity score matching incorporating 11 variables. Relapses 6-month confirmed disability worsening were assessed proportional cumulative hazard models. Matching resulted in 876 pairs (de-escalators: 73% females, median [interquartile range], age 40.2 years [33.6, 48.8], Expanded Disability Status Scale [EDSS] 2.5 [1.5, 4.0]; non-de-escalators: 40.8 [35.5, 47.9], EDSS 4.0]), follow-up 4.8 (IQR 3.0, 6.8). Patients faced increased future relapses (hazard ratio 2.36 95% confidence intervals [CI] [1.79–3.11], p < 0.001), which was when considering recurrent (2.43 [1.97–3.00], 0.001). It also consistent subgroups stratified age, sex, disability, duration, time since last relapse. On basis observational analysis, not be recommended universal strategy RRMS. The decision de-escalate should on individual basis, its safety clearly guided specific patient characteristics evaluated study.